'Accredited' living facilities.

Analyzing the costs and benefits of credentialing your ALF 

The COMMISSION ON ACCREDITATION OF REHABILITATION Facilities (CARD recently published its first standards manual for assisted living. The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) is expected to release a standards manual within the next few months. Each of these organizations has indicated that accreditation surveys could begin as early as this summer or fall.

The reasons an organization may voluntarily choose accreditation are many and varied. In some health care settings, accreditation has become a requirement for consideration by payor sources and purchasers of service. Marketplace dynamics often demand that accreditation be used as the minimum standard for consideration, thereby excluding non-accredited providers from initial consideration, In some cases, payors infer that an independent review process lends an added level of confidence to these providers, suggesting they adhere to a certain level of quality and standard of care. This added level of confidence then can be communicated to their customers.

With the number of assisted living facilities continuing to grow, organizations are faced with a need to differentiate themselves. Accreditation offers a way to demonstrate commitment to a higher level of quality than is offered by competitors. Purchasers, providers, families, caregivers, and residents often recognize accreditation as an indicator of value and this may be given considerable consideration when choosing a facility.

Typically, the standards for health care accreditation programs focus on the rights and care of residents, and assisted living is no exception. Emphasis is placed on recognizing the fundamental rights of residents to be treated with dignity and respect and to be active participants in the care-delivery process.

Outcomes and quality of care receive considerable attention and emphasis in the accreditation process, with the ultimate goal for organizations to develop a plan whereby improvement of care and processes is an ongoing journey. CARF standards are divided into three sections: leadership, information and outcomes management systems, and assisted living services. While the JCAHO standards manual has not been released to date, preliminary information indicates that the manual will be divided into two sections: resident- focused functions and organization-focused functions. These two sections are expected to include subsections on consumer protection; rights and ethics; assessment and reassessment; resident services and education; continuity of services; health and wellness promotion; infection control; improving organization performance; leadership; and managing the environment, human resources, and information.

Are you ready?

Pursuing accreditation is a major decision, given the time and financial investment that is required to achieve and maintain it. A major factor in determining your organization's readiness for accreditation and survey lies with your administration. Your leaders must be willing to get personally and actively involved in the process and to support efforts to achieve compliance with the standards.

In addition, staff members must be ready to participate actively in and support the accreditation process. To achieve staff cooperation and input, you'll have to communicate to staff members the positive benefits accreditation offers residents and their families. Finally, your entire organization must embrace the accreditation process in such a manner that the changes made in preparing for a survey become a "way of life" for your organization. Employees who believe that survey preparation is required only a few months prior to survey, and quickly return to their old habits when the surveyors leave, will never achieve the benefits that accreditation was designed to offer, and ultimately will become disenchanted and disappointed in the accreditation process. It is imperative that everyone in your facility embrace a philosophy of "survey readiness at all times" and pay continuous attention to quality of care.

There is no evidence that accreditation is a "must" for any organization. Each organization must assess the demands of its prospective residents and payors to determine if it would be a wise investment. If you choose accreditation, the first step is to complete a thorough assessment of the status of your organization relative to the standards established by the accrediting agency. A mock survey is an excellent tool that will allow you to identify areas needing change or revision, which can then be prioritized. Follow this with a methodical plan to achieve compliance one step at a time that will allow you ultimately to achieve your goals and the attendant sense of accomplishment that accompanies this achievement.

Billye White, RN, BSN, CRRN is a healthcare accreditation consultant based in Jonesboro, Ark She has been actively involved in organization preparation for JCAHO and CARF surveys for 10 years.